Differences in depression, treatment satisfaction and injection behaviour in adults with type 1 diabetes and different degrees of lipohypertrophy

Ingvild Hernar, Johannes Haltbakk, Anders Broström

To assess the prevalence of lipohypertrophy, and to compare differences in external, personal, and regimen factors in adults with type 1 diabetes and different degrees of lipohypertrophy. Suboptimal insulin injection behavior is associated with lipohypertrophy, which may affect insulin absorption and lead to blood glucose fluctuations. Few, if any studies have investigated how external, personal, and regimen factors differ in people with type 1 diabetes and different degrees of lipohypertrophy. A cross-sectional study including adults with type 1 diabetes at a diabetes outpatient clinic in a Norwegian university hospital. Participants (n=215) were included consecutively at scheduled appointments. Sociodemographic-, diabetes- and insulin treatment data, and self-report questionnaires concerning patient activation (PAM), depression (PHQ-2), diabetes distress (DDS), type D personality (DS14), treatment satisfaction (ITSQ), and motivation (TSRQ), were collected. Lipohypertrophic injection sites were identified by palpation by diabetes specialist nurses. Lipohypertrophy was present in 53% and was more frequent in insulin pen users (63%) compared to insulin pump users (34%). Participants with two or more lipohypertrophic areas had higher depression scores, lower treatment satisfaction with glycemic control, higher bolus doses, and reported suboptimal injection behavior compared to those with no lipohypertrophic areas. There were no differences in patient activation, diabetes distress, type D personality, or motivation between the groups. Compared to pump treatment, pen treatment requires greater awareness of injection technique. Depressive symptoms and lower treatment satisfaction might affect diabetes self-management and glycemic control, but the association with lipohypertrophy needs further exploration. Lipohypertrophy is more frequent in insulin pen users compared to pump users. Nurses should focus on injection technique education, and should also screen for depressive symptoms and treatment satisfaction as those factors could be associated with development of lipohypertrophy. This article is protected by copyright. All rights reserved.